A Telemedical Approach to the Scre e n i n g of Diabetic Retinopathy: Digital Fundus P h o t o g r a p h y

O R I G I N A L A R T I C L E O B J E C T I V E — The importance of screening for diabetic retinopathy has been established, but the best method for screening has not yet been determined. We re p o rt on a trial of assessment of digital photographs by telemedicine compared with standard retinal photographs of the same fields and clinical examination by ophthalmologists. RESEARCH DESIGN AND METHODS — A total of 129 diabetic inpatients were s c reened for diabetic retinopathy by slit-lamp biomicroscopy perf o rmed by an ophthalmologist and by two-field 50° non-stereo digital fundus photographs assessed by six screening centers that received the images by electronic mail. Conventional 35-mm transparencies of the same fields as the digital photographs were assessed by a retinal specialist and served as the re fe rence method for detection of diabetic re t i n o p a t h y. Slit-lamp biomicroscopy was the re f e re n c e method for the detection of macular edema. R E S U LT S — The prevalence of any form of diabetic retinopathy was 30% (n = 35); of sightt h reatening retinopathy including macular edema, the prevalence was 6% (n = 7). The assessment of digital images by the six screening centers resulted in a median sensitivity of 85% and a median specificity of 90% for the detection of moderate nonproliferative or sight-thre a t e ning diabetic re t i n o p a t h y. Clinically significant macular edema (n = 4) was correctly identified in 15 of the 24 grading re p o rts. An additional seven re p o rts re f e rred the patients for furt h e r investigation because of concurrent diabetic re t i n o p a t h y. C O N C L U S I O N S — Te l e s c reening for diabetic retinopathy by an assessment of two-field 50° n o n - s t e reo digital images is a valid screening method. Although detection of clinically significant macular edema using biomicroscopy is superior to digital or standard non-stereo photographs, only few patients with sight-threatening diabetic retinopathy are missed.